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Really high ejection fraction

June 15th, 2005, 10:18 PM

Hello, I was reading through my annual check-up echo results (MVR ~2 years ago) and it hit me that my ejection fraction seemed to be too high (73%). I don?t have other numbers to compare with since only one echo actually has the EF value. Everything else says EF is normal, without any numbers. If EF was out of range below the normal values, that is a problem. However, how bad is it to have EF that?s too high? I used to think that that just meant my heart was doing a great job pumping blood out, but then a few weeks ago I saw tobagotwo post that EF being too high isn?t that good either, so now I?m really worried. I don?t think I have any unusual symptoms; I feel fine every day.

My LV size (end diastole) is 4.0 cm, and LA size is 2.7cm. Aortic Cusp Separation is 1.6cm, which is really close to being out of range also that it?s starting to worry me.

Is EF of 73% really as dangerously high as I think it is? Is there anything I should be aware of now regarding this and possibly my aortic valve (nothing was ever mentioned to me about this valve before)? Any comments will be greatly appreciated. Thank you!

If your EF is at 73% that means your heart function is good. I won't worry about it being too high. Mine is at 77% (result from a stress test) and they said it was good. I have a dilated aorta (4.0 cm) As (valve size ~1.4 cm) BAV, and moderately/severe regurgitation. At the moment the cardiologist doesn't seem to feel that I should worry about anything even though I am symptomatic. But if you are still freaked out.....ask your doctor about it....perhaps there is new info out there that neither one of us is aware of.

Comment

My understanding (which MAY not be complete or accurate) is that a "Too High" EF can be an indication that the heart is "compensating" for a diseased valve (small opening) by 'pumping harder'.

Supposedly this can lead to progressive enlargement of the heart which can become permanently damaged if allowed to continue for "too long". How long is too long? That seems to vary from individual to individual.

Bottom Line: ASK your Cardiologist about what is "too high an EF" and also ask about chamber enlargement. When it comes to setting the time to have surgery, I highly recommend involving a SURGEON as surgeons typically like to operate BEFORE there is any permanent damage.

Comment

The word dangerously shouldn't be mixed in there, I'm sure. These things usually take years to develop. Also, EF varies greatly in an individual, and therefor requires several measurements to be reasonably sure of an accurate reading. I don't mean to frighten anyone, and I regret if I have caused that for you.

A higher ejection fraction usually indicates hypertrophy, which is some enlargement of the heart due to stress. The heart muscle compensates for stenosis or regurgitation by growing stronger and larger. When it does that, it becomes more capable and efficient, raising your ejection fraction. The problem is that the growth isn't sustainable, and the heart actually starts to outgrow its efficiency eventually.

I had an EF of 77 before surgery, and I thought it was great. I even said so in a post or two. My cardiologist thought different. When I looked it up at the time, I found the 50%-65% range and didn't feel so special anymore.

-----

I just went for a whirlwind tour of EF site mentions, and the results follow: Mayo says 55%-70%; Heart1 and and HeartCenterOnline say 55%-75%; Surgeon1 says 50%-75%. That is more in line with the other numbers I have been seeing posted than with mine. I was all over the ACC and AHA sites, and couldn't find a mention of a normal range :mad: I can't find the original site that said 50%-65% either.

I did find this mention of increased EF: in the ACC guidelines:

Another problem that is particularly common in elderly patients, especially women, is an excessive or inappropriate degree of hypertrophy; wall thickness is greater than necessary to counterbalance the high intracavitary pressures (66-69). As a result, systolic wall stress is low, ejection fraction is high, and the ventricle resembles that seen in patients with hypertensive hypertrophic cardiomyopathy of the elderly (70).

Right-sided heart failure...causes diastolic dysfunction, in which fluid entering the heart backs up, causing the veins in the body and tissues surrounding them to swell. In such cases, the ejection fraction is paradoxically normal or high.

I have not been able to re-find the original citing, so please take heed of the Mayo and heart site numbers. It is possible that the original site revised its numbers since I saw them and took them to heart. I am sorry to have caused you such a level of concern.

Best wishes,

Bob H

"No Eternal Reward will forgive us now for wasting the dawn..." Jim Morrison

[B]I am not a Medical Professional.[/B] Aortic Valve Replacement (Medtronic Mosaic) on 4/6/04, at Robert Wood Johnson UH in New Brunswick, NJ. AVR again (St. Jude Biocor) on 08/25/09 at St. Michael's MC in Newark, NJ. Both performed by Dr. Tyrone Krause, a true Zen Master Mechanic in the world of valve replacement surgery.

Comment

Thank you very much for your comments. What I should probably do now, after my wisdom teeth are taken care of, is to get an echo and request that all numerical values be given to me instead of just saying something ?looks normal,? and clarify all of my concerns with the cardio. It was just that the combination of high EF, trace tricuspid regurgitation, and mild RV dilation really did not sound good to me. But because those assessments were gleaned from three different echo results, and they each say different things on its own, I wasn?t too sure what to make of it.

Bob-I really didn?t mean to point the finger at you in any way. The reason I mentioned your previous comment was that it made sense (outliers are outliers for a reason, right?) and made me look at my echo results differently. I actually appreciated that comment since I?d rather worry about something than be unaware of possible problems. I was probably just being a bit more sensitive than usual last night, especially after reading for the first time my medical records from the hospitalization that led to the emergency MVR, and the notes from the days following my crash to the surgery were a bit spooky. I?m sorry to have alarmed you with my overreaction, and thank you for taking the time to look up the ranges for EF.

Comment

It is now 70%...or at least it was a year ago. He has right sided heart failure....enlarged liver, etc. From my understanding the heart is over compensating for the regurgitation, and the EF will decline, when the heart can no longer keep up.

Marybeth

Edit

Comment

Your plan sounds excellent, excepting that I would also ask them for the complete editions of the earlier echoes. They should have them in their files, and the more information you have, the better you can plot your heart's progression, if any.

Trivial regurgitation comes and goes all the time in different valves in most hearts, and is generally considered insignificant, so I wouldn't let that concern you. It may be there one reading, and gone on a reading a month later. Then it may show up on another valve for awhile. The heart is a dynamic and muscular organ, and small, temporary shifts in shape, size, or even effort can momentarily deform the valve opening enough to cause a tiny, but detectable regurgitation. The techs report it, just to show that they saw it and were paying attention, but it is labeled trivial because it is not of any functional importance.

As far as the EF numbers, Nia, I'm glad you did bring it up. It's a common human failing to want to go with the familiar. I have had that EF range locked in my brain for a long while, and have used it with confidence, based on my original fiind of it.

However, things change. "Knowledge," such as a definitive normal range for ejection fractions, is not a reliable, concrete constant, but rather evolves. Especially in this field. It's a great temptation to find an answer, put a stake in the ground, say that "this is so," and stick with it, no matter what. But in truth, to try to keep up with what's going on in valve-related information, we have to have intellectual feet of clay. Health information rumbles through the knowledge field like a series of small earthquakes, always requiring you to reexamine afterwards which side of the road is the stable ground.

Your concern made me revisit this information, and it was apparently time for it. What I was touting appears to be old hat now, and I thank you for unintentionally prodding me to update it.

I do suspect that the higher EFs that are now listed as normal are probably related to an increase in the number of fitness buffs and practitioners of extreme sports, such as long-distance runners and cyclists, rather than an acceptance of those higher EFs as ordinary in the average run of people, though. Atheletic people sometimes have heart enlargement because of the massive amount of exercise involved (sometimes referred to as "athelete's heart"), as well as the increased ejection fractions that go with it.

I think the significance of the higher EFs could most reasonably be considered in relation to both overall athleticism and other findings within the heart. If you are of average or slightly better fitness, but have a mild to moderate valve leak, the leak should be suspected of causing any enlargement and higher EF, as I believe it takes a high level of fitness activity in most people to push an EF above 65% or so.

The higher EFs are indicative of the heart coping with a situation. The distinction is whether it is a high level of exercise demanding more oxygen in the body (and thus increased pumping), if the demand is caused by needing to pump harder through a narrowed opening (stenosis), or if there is a regurgitation that allows the pumped blood to leak back into the pumping chamber, undermining its efforts.

Best wishes,

Bob H

"No Eternal Reward will forgive us now for wasting the dawn..." Jim Morrison

[B]I am not a Medical Professional.[/B] Aortic Valve Replacement (Medtronic Mosaic) on 4/6/04, at Robert Wood Johnson UH in New Brunswick, NJ. AVR again (St. Jude Biocor) on 08/25/09 at St. Michael's MC in Newark, NJ. Both performed by Dr. Tyrone Krause, a true Zen Master Mechanic in the world of valve replacement surgery.